Five Multiple-Choice Questions on Functional Bladder Disorders in Children
Question 1: Diagnostic Approach to Dysfunctional Voiding
A 7-year-old child presents with daytime wetting and recurrent UTIs. According to ICCS guidelines, how many uroflowmetry studies should be performed in the same setting to confirm dysfunctional voiding?
A) One abnormal flow curve is sufficient for diagnosis
B) Two consecutive abnormal patterns are required
C) Up to 3 flow/residual measurements in a well-hydrated child
D) Uroflowmetry is not necessary; voiding diary alone is adequate
Correct Answer: C 1
Rationale: A single abnormal uroflow curve is insufficient because any child can produce a pathological pattern under stress. However, a normal flow curve provides confidence that dysfunctional voiding is absent. The ICCS recommends repeating flow/residual measurements up to 3 times in the same setting with a well-hydrated child to confirm the diagnosis.
Question 2: Treatment of Constipation in Dysfunctional Voiding
What percentage of children with increased post-void residual urine and constipation showed improvement in bladder emptying after treatment of constipation alone?
A) 25%
B) 45%
C) 66%
D) 89%
Correct Answer: C 1
Rationale: Studies demonstrate that 66% of children presenting with increased post-void residual urine and constipation had improvement in bladder emptying after treating constipation alone. Additionally, treatment of constipation resulted in 89% resolution of daytime wetting and 63% resolution of nighttime wetting.
Question 3: Uroflowmetry Pattern in Detrusor Underactivity
A child with detrusor underactivity undergoes uroflowmetry. Which pattern is characteristic of this condition?
A) Bell-shaped curve with normal flow rate
B) Staccato pattern with multiple peaks
C) Interrupted pattern with low maximum flow rate, large voided volumes, and prolonged voiding time
D) Plateau-shaped curve with sustained high flow
Correct Answer: C 1
Rationale: Detrusor underactivity characteristically shows an interrupted uroflowmetry pattern with low maximum flow rate, large voided volumes, and prolonged voiding time. A curve with sharp rise then slower downside can indicate detrusor overactivity with impaired contractility.
Question 4: First-Line Urotherapy Components
According to ICCS guidelines, which technique is specifically recommended for children with increased post-void residuals, particularly in the morning and at night?
A) Timed voiding every 2 hours
B) Double voiding (several toilet visits in close succession)
C) Fluid restriction after 6 PM
D) Anticholinergic medication
Correct Answer: B 1
Rationale: Double voiding—several toilet visits in close succession—is a useful technique for children with increased post-void residuals. It should be recommended at least in the morning and at night if not achievable during the school day. This is part of urotherapy aimed at optimizing bladder emptying efficiency.
Question 5: Success Rates with Escalating Treatment
What success rate has been achieved with an escalating treatment approach (starting with education/urotherapy, progressing to biofeedback, then medications if needed) for dysfunctional voiding in children?
A) 40-50%
B) 60-70%
C) 75-85%
D) 90-100%
Correct Answer: D 1
Rationale: Comprehensive programs using an escalating treatment approach have achieved success rates of 90-100%. This begins with education and urotherapy (which alone cures up to 20% of cases), progresses to biofeedback sessions, and reserves pharmacological therapy for selected patients with mixed disorders. Only a small minority require medications, and refractory cases proceed to full urodynamic studies or MRI.